When the hospital receives a call
that a radiation accident victim is to be admitted, a planned course of action should be
followed. The individual receiving the call should get as much information as possible,
including the following:

1. Number of accident victims

2. Each victim's medical status and mechanism of
injury

3. If victims have been surveyed for contamination

4. Radiological status of victims (exposed vs.
contaminated)

5. Identity of contaminant, if known

6. Estimated time of arrival

If any doubt about contamination exists, assume the
victim is contaminated until proven otherwise. Advise ambulance personnel of any special
entrance to the emergency department for the radiation accident victim. If the accident
notification comes from a source other than usual emergency communications, get a
call-back number and verify the accident prior to assembling the radiological emergency
response team and preparing for patient admission.

Each member of this team should be familiar with
the hospital's written plan and be required to participate in scheduled drills. More
frequent drills (quarterly or semiannually) should be considered by subgroups such as
decontamination, triage, or radiological monitoring. Special training must be instituted
to accommodate staff turnover. Training should also be part of the hospital inservice
program and should include EMTs and paramedics since they play an important role in
assisting the emergency department staff through notification procedures before arrival
and proper transport of radiation accident victims.

Radiological
Emergency Response Team

Personnel
Role

Function

Team coordinator

Leads, advises, and coordinates

Emergency physician

Diagnoses, treats, and provides emergency
medical care; can also function as team coordinator or triage officer

The purpose of protective clothing is to keep
bare skin and personal clothing free of contaminants. Members of the radiological
emergency response teams should dress in surgical clothing (scrub suit, gown, mask,
cap, eye protection, and gloves). Waterproof shoe covers also should be used. All open
seams and cuffs should be taped using masking or adhesive tape. Fold-over tabs at the end
of each taped area will aid removal. Two pairs of surgical gloves should be worn. The
first pair of gloves should be under the arm cuff and secured by tape. The second pair of
gloves should be easily removable and replaced if they become contaminated. A radiation
dosimeter should be assigned to each team member and attached to the outside of the
surgical gown at the neck where it can be easily removed and read. If available, a film
badge or other type of dosimeter can be worn under the surgical gown. A waterproof apron
can also be worn by any member of the team using liquids for decontamination purposes.

This protective clothing is effective in
stopping alpha and some beta particles but not gamma rays. Lead aprons, such as those used
in the x-ray department, are not recommended since they give a false sense of security --
they will not stop most gamma rays.

If possible, select a treatment room near an
outside entrance. Clear the area of visitors and patients. Remove or cover equipment that
will not be needed during emergency care of the radiation accident victim.

Several large plastic-lined waste containers
will be needed. The treatment table should be covered with several layers of waterproof,
disposable sheeting. Plastic bags in all sizes will be needed and should be readily
available.

Survey instruments should be checked and ready
for use before the patient arrives. Background radiation levels should be documented.

The treatment team should be prepared to meet
the patient at the ambulance where the patient can be transferred to the prepared
treatment gurney.

Rolls of brown wrapping
paper or butcher paper three to four feet wide can be unrolled to make a path from the
ambulance entrance to the decontamination room. Ordinary cloth sheets or square absorbent
pads can be used if paper is unavailable. Whatever the floor covering, it should be
taped securely to the floor. This route should then be roped off and marked to prevent
unauthorized entry. The floor of the decontamination room or treatment area should be
covered in a similar way if time allows. This will make cleanup of the area easier.

A control line should be established at the
entrance to the decontamination room. A wide strip of tape on the floor at the entrance to
the room should be marked clearly to differentiate the controlled (contaminated) from the
non-controlled (uncontaminated) side.

While it may be desirable
that the room, or rooms, have either a ventilation system that is separate from the rest
of the hospital or a means of preventing the unfiltered exhaust air of the radiation
emergency area from mixing with the air that is distributed to the rest of the hospital,
there is very little likelihood that contaminants will become suspended in air and enter
the ventilation system. Hence, no special precautions are advised. (Ref.: AMA. A Guide to
the Hospital Management of Injuries Arising from Exposure to or Involving Ionizing
Radiation. 1984).